National Firefighter Registry for Cancer

The National Firefighter Registry for Cancer (NFR) is a voluntary registry of firefighters in the United States used to evaluate cancer rates and risk factors in the U.S. fire service through collecting relevant occupational, lifestyle, and health information on firefighters. It aims to use these data to reduce cancer in firefighters.

The NFR was created by the Firefighter Cancer Registry Act of 2018 in response to growing evidence of carcinogenic exposures and increased risk for cancer faced by firefighters. It opened to registration by firefighters in April 2023. The NFR is maintained by the U.S. National Institute for Occupational Safety and Health (NIOSH) but was shut down by the Trump administration in April 2025.

Cancer risk in the U.S. fire service is a topic of growing concern. Firefighters regularly encounter carcinogenic materials and hazardous contaminants on the fireground. Several studies have documented airborne and/or dermal exposures to carcinogenic compounds during firefighting, as well as contamination on turnout gear and other equipment worn by firefighters.  Some of these compounds have been shown to absorb into firefighters' bodies. Some firefighters also work with hazardous materials and are trained to control and clean up dangerous materials such as oil spills and chemical accidents. In addition to chemical exposures, night shift work has been classified by IARC as a probable human carcinogen.

Unlike structural firefighters, wildland firefighters typically do not wear respiratory protection, and may inhale particulate and other compounds emitted by the wildfires. A risk assessment conducted using an exposure–response analysis concluded that wildland firefighters could have an increased risk of lung cancer mortality.

Recent studies suggest that exposure on the fireground may increase risk to firefighters of certain types of cancer and other chronic diseases. In addition to epidemiological studies, several mechanistic studies using biomarkers have found evidence of DNA damage, oxidative stress, and epigenetic changes related to firefighters' exposures.

In 2022, IARC completed an evaluation on the carcinogenicity of the occupation of firefighting and reached a consensus classifying it as a known human carcinogen. This classification was based on sufficient evidence for increased risk of mesothelioma and bladder cancer among firefighters. Limited evidence of increasing risk among firefighters was also found for five other cancers: colon, prostate, testicular, melanoma of the skin, and non-Hodgkin lymphoma.

While U.S. state cancer registries provide rich data for studying cancer in the U.S., they often do not provide comprehensive information on cancer patients' work history and workplace practices, making it challenging to use this data source alone for studying cancer in firefighters. It is also important to collect information on personal and lifestyle risk factors (e.g. tobacco and alcohol use, sleep deprivation, diet, and physical activity) in the U.S. fire service to better understand how they may affect the relationship between firefighting and cancer.

Due to the lack of central and comprehensive sources of data, research on cancer rates amongst firefighters has been challenging. Although some evidence suggests the risk for specific cancer types could vary for male, female, and non-white firefighters, the strength of the evidence related to cancer in demographic subgroups is limited because many previous studies have mainly comprised white male samples of firefighters. Larger samples of female firefighters and minority groups are needed before the conclusions can be drawn about cancer risk across the nation's diverse fire service. Additionally, the research on cancer for some subspecialty groups of firefighters, such as firefighter trainers, is limited.